ADeks

I took the CEN today and passed. Yayyy!!! I used Sheehy's Manual and Jeff Solheim has free printouts that go along with his lectures. I also used those when I was at work to look at some information quickly when I had a few minutes.

Do any of your ERs use warm lidocaine for anesthetic during suturing? I was wondering how do you warm the lidocaine? Ours usually comes in 10ml plastic vials. The one with epi comes in glass... I was studying for my CEN and ran across this. Thought it would be a good idea especially for some of our pedi patients.

I'm visiting a family member in the ER and my back hurts so I'd like a bed to sleep.

I work in the ED and we will run the 4mg/250ml for peripherals and 16mg/250 for PICC/CL. Sometimes the MD isn't willing to place an central line before sending the patient up to ICU.

My hospital is not a Level 1 trauma ER. We do however get trauma codes and police are there to help identify the patient and help find a contact person. Also if a trauma alert goes south as in the patient dies. Then the patient is basically a crime scene. So the police need to remain there to maintain chain of custody as others have pointed out. Maybe with what you saw the staff could have done better? I couldn't tell you, but I wasn't there.

I've only had one cyclic vomiter that made me believe in him. He wasn't even complaining of pain really just that awful feeling retching. Which I believed.

I feel like I'm always getting stronger about being able to feel sick vs. not sick. Another, helping factor another nurse taught me. Touch the patient. And I feel like it's so true. You just get more of an idea when you feel that cold clammy arm... Lol.

Well, from my understanding if someone is suing the hospital. The attorney casts a very wide umbrella to try and find anyone at fault... So you could be apart of this lawsuit with or without insurance. Obviously, if you do have your own insurance and at fault they will get more of a payout from your personal insurance and the hospital. Keep in mind though, whatever company you work for, their lawyers work for the company to protect them not really you. I have heard of stories where the company covered the nurse during the lawsuit but then fired that same nurse afterwards. I would rather take the chance of getting pulled into a lawsuit knowing I have my own lawyer than just relying on the facility. Also, if you no longer work at that facility, they have no obligation to support you during a later lawsuit. Words for thought.

For kidney stones, the usual order is Toradol 30mg iv, Zofran 4mg iv, and Dilaudid 0.5 mg iv. Then off to CT to r/o kidney stones. I was talking to an ER doc and she told me there's a big push for better pain control in a 'timely manner'. Especially within so much time of signing in. I just figured it was to get control of their initial pain.

My ED does the same thing with the foley. It's a radiology thing. Patients can refuse, but I have seen them send patients back saying their bladder isn't full enough. They also insist they can't do the US until the HCG quant has resulted. Which to me, doesn't make sense because they don't read the US, the radiologist does. By the time they read it, it'll be back.

We don't need consent to do a UDS. But I had a patient refuse to provide a urine specimen in the ER because he figured we were going to do one when we asked for a urine specimen. He was right. There were questions about him being homeless, clearly high, and a child's care. Anyways, a police officer was there and basically told him you're considered positive for illegal drugs since you're refusing and called CPS.

I would ask the patient. I work in the ER and it depends. Sometimes depending on the port we still need a peripheral iv. We don't usually heparinize the port in the ER.

I wonder if the push for MSN bedside RNs will stick. And if there is any pay increase?! The difference between ASN and BSN in the south is minimal.

We've been having the same problem. Though the admitting MD is supposed to put orders in within a certain amount of time. If there is anything more pressing like their BP is high and they usually take nightly BP meds, I'll try and get the ED doc to write up a dose. All else fails call the admitting doc! Initially, I tell patients that when the MD puts the orders in we or the floor will either catch them up that night or they will skip a dose and restart in the AM. They usually understand.

We have a PA that starts orders based on triage interview from 9a-9p. That same PA May d/c some of the less complicated patients from the waiting room basically. We do have a designated fast track 11a-11p, but that's seen by PAs and MDs. We are a high-volume, 46 bed ER. We get a lot from both doors so depending on what's going on in the back we have long door to doc times. So having the PA there cuts down. Plus I'm pretty sure it cuts the LWOTs because if they were seen in triage with the PA, if they were to leave it's now an AMA